Karen Garloch

Charlotte doctors find less radiation best for treating certain brain cancers

Two Charlotte cancer specialists are co-authors of a new study that shows some brain cancer patients can be treated effectively with a less toxic form of radiation that produces fewer memory problems and cognitive side effects.

The study, published Tuesday in the Journal of the American Medical Association, compared whole brain radiation, the current standard of care, with more-focused radiation, also called radiosurgery. In the patients studied, the latter therapy was found to be just as effective in terms of survival, but caused fewer side effects.

“In the past, we were so focused on metrics – how many lesions are there? How long is he living? – and nobody was asking how (patients) were functioning on a daily basis,” said Dr. Tony Asher, a neurosurgeon with Carolinas Neurosurgery and Spine Associates and senior author of the study.

“…When two cancer therapies produce similar survival, it’s important to understand which therapy offers patients a better quality of life,” Asher said.

Asher and Dr. Stuart Burri, a radiation oncologist with Southeast Radiation Oncology Group, are among several authors of the 12-year study. The study involved more than 200 patients from 34 centers, and assessed both brain tumor patients’ cognitive functioning and quality of life as well as survival after treatment.

More than 50 patients were treated at medical centers in the Carolinas, and about half of those came from Levine Cancer Institute, a part of Carolinas HealthCare System in Charlotte. Other patients were treated at centers in Texas, Minnesota, Florida, Pennsylvania, Massachusetts, Iowa and Canada.

The study compared treatments for patients who had one to three brain tumors that had spread, or metastasized, from other parts of the body. All patients received focused radiation, but some also received whole brain radiation.

Patients who got whole brain radiation “reported worse quality of life compared with patients who only received focused radiation,” Burri said. Data also showed that adding whole brain radiation “produced no improvement in survival.”

The study found that “patients receiving whole brain radiation had significantly more difficulties with memory and complex thinking than patients who only had the focused radiation,” Asher said.

The debate over radiation treatment for brain tumors “remains a very controversial area in oncology,” Asher said. “We know that whole brain radiation therapy dramatically reduces the development of new lesions. The question is at what cost.… The tradeoff is that (patients) develop bad side effects. They may look okay, but what you don’t know is that they can’t balance their checkbook.”

Advocates of whole brain radiation emphasize the treatment’s ability to decrease the number of new lesions and believe “they need to be stopped before they occur,” Asher said.

But he said patients who get new lesions after having focused radiation can be treated again. That would be as effective and less toxic, he said, than “giving them a whole bunch of whole brain radiation upfront, and giving them a bunch of neurocognitive symptoms.”

About 400,000 patients develop metastatic brain cancer each year, according to the American Cancer Society. If focused radiation only can treat just 20 percent of patients, Asher said that would mean “tens of thousands” of patients whose “quality of life will be improved.”

In a JAMA editorial, Dr. Carey Anders and two other physicians from UNC Chapel Hill Lineberger Comprehensive Cancer Center wrote that this study resolves the debate over which treatment is appropriate for patients with one to three brain metastases, noting there is “little role” for whole brain radiation.

But the editorial warned that the study results should not suggest that focused radiation is the standard for patients with four or more metastases or that whole brain radiation should no longer have a role.

In the future, Anders said researchers will be interested in comparing treatment for the three cancers most likely to spread to the brain – breast, lung and melanoma. While the new study reviewed all types of brain tumors, Anders said it will be helpful to “understand how the nuances will play out in different solid tumors.”